Mr Banwell provides expert comment in Daily Mirror

Mr Paul Banwell was quoted extensively in the Daily Mirror yesterday about the need for greater regulation in Cosmetic Surgery. Mr Banwell, a well known cosmetic surgeon in the South East, believes patient safety is paramount and the consultation process is key to having realistic expectations. For a link please click on the following

Paul Banwell in The Independent discussing Skin cancer

Mr Banwell appeared in The Independent today discussing a recent survey examining the British publics attitudes to sun exposure. This large study was conducted by Nuffield Health. Click on the link for further details. Remember to minimise your sun exposure and use sun protection regularly


Macrolane Withdrawn in UK

Mr Banwell notes BAPRAS’ Vice President Graeme Perks commments on Macrolane.

“BAPRAS believes it is critical that every patient in the UK – whether being treated on the NHS or privately – is protected before, during and after their surgery. If there is any doubt about the safety and efficacy of a product it should not be used. We therefore support the withdrawal of the dermal filler Macrolane for breast augmentation.

“The recent examples of PIP breast implants and now Macrolane reiterate how important it is for cosmetic interventions to be properly regulated within the UK. We continue to work closely with the Department of Health to review current regulation and make recommendations for the future. We would to see a mandatory register for breast augmentation as part of this, with all types of ‘implant’ included.”

23 April 2012

Does Plastic Surgery Benefit the Poor?

Mr Banwell notes a recent article published by ASAPS below.

Plastic surgery considered a health benefit in Brazil – ASAPS 17 April 2012

While plastic surgery is considered a luxury in America, in Brazil it’s considered a right.
A recent Associated Press report in the Daily News revealed that thousands of the country’s poor have undergone plastic surgery procedures such as Botox injections, laser hair removal, chemical peels and laser treatments free of charge.
According to the AP, more than 220 clinics throughout the country offer free or discounted plastic surgery to those who wouldn’t otherwise be able to afford it. The reason – these procedures help boost self-esteem and enable patients to feel more confident about themselves.
“What’s a wrinkle? Something minor, right? Something with precious little importance,” a Rio de Janeiro-based plastic surgeon, told the AP. “But when we treat the wrinkle, that unimportant little thing, we’re actually treating something very important: The patient’s self esteem.”
Dr. Ivo Pitanguy, the “philosopher of plastic surgery” in Brazil founded the first surgical center to treat the poor, mainly focusing on burn victims and those with deformities, but also offered discounted cosmetic surgery. Now, the growing numbers of hospitals and clinics that offer these services have long lines and waiting lists. Once a surgery is approved by a physician, patients might wait years to undergo their desired procedure.
And while the cosmetic procedures are beneficial to those undergoing them, it can also be argued that there’s a benefit for the providers as well, as they allow young doctors to gain experience.
Brazil, a common destination for medical tourists seeking discounted plastic surgery procedures, is the world’s top plastic surgery provider, with the United States coming in second place.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), more than 9.1 million plastic surgery procedures were performed in the US in 2011. The most common cosmetic surgeries included liposuction, breast augmentation, tummy tucks, cosmetic eyelid surgery and breast lifts. The most common nonsurgical procedures included botulinum toxin type A injections, hyaluronic acid injections, laser hair removal, microdermabrasion and laser treatments.


Mr Banwell notes this recent post by Safter Cosmetic Surgery.

As concerned women with PIP implants come forward for reassurance and treatment the Department of Health (DH) continue to investigate the scandal.

Recent statistics from the Department of Health have revealed to date 4,872 referrals have been received by the NHS from patients who had their initial surgery at a private clinic. 280 of these referrals were received last week by 120 trusts.

So far 2,393 scans have been undertaken, leading to 252 decisions for explants to take place.

It was confirmed earlier in the year; patients who received PIP implants on the NHS will be contacted and offered removal and replacement procedures. The NHS has also agreed to help women who have been rejected by their initial private clinic by removing the faulty implants; but they are unable to replace them.

The DoH announced today the NHS will replace PIP breast implants for private patients if their reason for having implants was part of a reconstruction following breast cancer.

The ‘NHS offer’ to private patients with PIP implants varies depending on the circumstances of each patient, not all women will be advised to have their implants removed at this time, some women will simply want reassurance. 1,303 women have completed their NHS offer, 119 of these were completed last week.

The latest estimate of the number of women with NHS PIP implants in place is 748. So far 743 women have been contacted by the NHS and 112 decisions have been made to replace the implants. 37 scans have been recorded and 30 women have completed their NHS offer.

SaferCosmeticSurgery would like to reiterate the advice from the Department of Health and the British Association of Aesthetic Plastic Surgeons (BAAPS):

All patients are advised that they should be aware of the make of their implants. Those patients unsure of these details are advised to contact their surgeon/provider. Patients are advised that BAAPS agree with the DoH expectation that patients should not be charged to access their notes. All NHS patients who have a PIP implant will be contacted by their hospital.

Signs and symptoms of rupture/leak/inflammation in one or both breasts may include:

– Lumpiness of the breast
– Lumpiness/ swelling of the regional lymph nodes in the underarms and rarely in the neck
– Change in shape and size of the breast
– Redness of the skin
– Tenderness of the breast and or the lymph glands in the underarms
– Swelling of the breast
– Firmness of the breast
– Pain
– Hyper sensitivity

The advice to patients is that those who experience signs or symptoms of rupture or irritation should seek advice earlier. Those who do not have complaints but have concerns and wish to discuss the risks and benefits of implant exchange should also seek advice at some stage.

Mr Banwell notes study on facial surgery


A study by the Archives of Facial Plastic Surgery has found surgery turns back the clock on average 7 years of ageing.

The aim was to help patients considering surgery to have clearer expectations of what can be achieved before going under the knife. The study was lead by Dr Nitin Chauhan a plastic surgeon at the University of Toronto.

Before and after photos of 53 women and 7 men all aged 60 were shown to 40 first year medical students. They were asked to estimate the ages of the patients before their surgery and then afterwards.

The patients had undergone a variety of facial cosmetic surgery, ranging from one to three procedures; 22 had a face and neck lift, 17 had a face and neck lift as well as an eyelid lift and a further 22 had a face and neck lift, eyelid lift and brow lift.

According to the study, patients’ ages were reduced on average by 5 to 7 years following one procedure such as a face lift or neck lift. Patients who went under the knife for two facial procedures were estimated 7.5 years younger, in comparison; patients who had three procedures were thought to be 8.4 years younger.

Other experts in the field including Dr Garry Brody, professor of plastic surgery at the University of Southern California, warned patients to remain realistic about what surgery can achieve for them personally.

PIP breast implant boss arrested in France

The owner of a French breast implant maker at the centre of a safety scare has been arrested in southern France.

Poly Implant Prothese (PIP) founder Jean-Claude Mas, 72, was held at his home in Six-Fours-les-Plages, police sources told reporters.

In 2010, France banned PIP implants made with low-grade industrial silicone, amid fears they could rupture and leak.

Up to 400,000 women in 65 countries are believed to have been given implants.

Mr Mas remains at his home while police search it – as required by French law.

He is believed to have been detained as part of a judicial investigation started in December into manslaughter and involuntary injuries.

A second PIP executive, former chief financial officer Claude Couty, has also been arrested

Mr Mas has been under investigation since he revealed in a police interview last year that PIP ordered employees to hide the unauthorised silicone when inspectors visited its factory.

He told police that PIP had deceived European safety inspectors for 13 years.

But he has insisted they posed no threat to health and attacked the French authorities for offering to pay for their removal because it put women through a “surgery risk”.

What are the risks?

  • The silicone inside the implants is not medical grade – but was intended for use in mattresses
  • Tests have not shown any increased risk of toxicity from this filler compared with normal implants
  • But mechanical testing has shown the implant covers have an increased risk of rupturing
  • The gel inside can be an irritant, increasing the risk of inflammation – making removal more difficult
  • There is no increased breast cancer risk
  • One case of a rare form of cancer called anaplastic large cell lymphoma (ALCL) was recently reported in France
  • French and US experts suggest there is a small but increased risk of this cancer in women with breast implants in general

He also said he had “nothing” to say to women facing surgery for their removal and that victims had only filed complaints “to make money”.

Excerpts from Mr Mas’s interview have been re-examined by a French magistrate.

The BBC’s Christian Fraser in Paris said he had been “quite arrogant” about what had happened and had not felt any remorse.

In France, 30,000 women have been advised to remove the implants and 2,700 have filed complaints against Mr Mas.

Women in 65 countries – mainly in Latin America and elsewhere in Europe – have received implants made by the company, which closed down in March 2010.

Health officials in Germany, the Czech Republic and Venezuela have advised women to have them removed.

But the medical advice in the UK, where 40,000 are affected, is that there is no need for all the implants to be removed, only those causing problems such as pain or tenderness.

In England, the NHS will only replace them in exceptional circumstances, and the NHS in Wales said it would only do so when it was deemed medically necessary.

Women in Northern Ireland who received PIP implants for health reasons will have them replaced, but the NHS will only remove, not replace, those inserted for cosmetic reasons.

Scotland’s Health Secretary Nicola Sturgeon said concerned women who had them fitted privately would be offered advice and the option of removal if necessary. There are no records of PIP implants being used by the NHS.

The international police agency Interpol has said Mr Mas is wanted in Costa Rica over a drunk driving charge.

It said the “red notice” over an alleged incident in June 2010 was “totally unconnected” to PIP.

– BBC News, 26 January 2012

Plastic Surgery Regulations Reviewed

Health secretary Andrew Lansley has announced that an expert review into the regulations of cosmetic surgery will be lead by NHS medical director Sir Bruce Keogh. The review follows the recent concerns over defective French manufactured breast implants Poly Implant Prothese (PIP) which has left an estimated 40,000 UK women anxious over the effects of their faulty breast implants.

The government’s investigation will look into:

  • how the cosmetic sector can improve the quality and safety of care through better governance based on better quality data collection and improved professional development;
  • whether cosmetic products and interventions are appropriately regulated; and if not
  • how regulation of the sector in the UK and in Europe can be improved.

The Care Quality Commission will also be reviewing private providers of cosmetic surgery, to determine whether or not they “meet essential levels of safety and quality” and provide adequate levels of support to their patients. Mr Lansley said the Commission “has a wide range of enforcement powers that it can use to protect the safety of patients”.

In the UK general practitioners can legally perform breast augmentation and liposuction procedures without significant training. Similarly, beauticians can legally perform non-surgical treatments in their high street and mobile salons such as anti-wrinkle and filler injections.

Professor Sir Bruce Keogh, said: “The vast majority of practitioners in the cosmetic industry are professional and well skilled – but I’m concerned that the sector as a whole does not have the systems for monitoring the results for patients and alerting us to possible problems.  I will work with the industry to improve regulation and governance and increase consumer confidence.”